Dietary supplement use linked with improved survival in patients with solid tumors

In the September 1, 2009 issue of the International Journal of Cancer, Norwegian researchers report that women with solid tumors who used dietary supplements prior to diagnosis had better survival compared to nonusers.

For the current analysis, researchers at the University of Tromso evaluated data from participants in the Norwegian Women and Cancer study, which began in 1991. Dietary questionnaires completed by the participants between 1996 and 1999 provided information on type and frequency of supplement use. The analysis was limited to 4,242 patients diagnosed with their first cancer between the time of completion of the questionnaire and 2007. Participants included those with breast, colorectal, lung and other solid tumors.

Cod liver oil was the most frequently reported dietary supplement used by this Norwegian population, followed by multivitamins and minerals. Women with solid tumors who reported using cod liver oil daily throughout the year had a 23 percent lower risk of dying over the study period compared to nonusers. For those who reported occasional use of other dietary supplements, there was a lower risk of mortality from all solid tumors. A reduction in the risk of dying of lung cancer was particularly associated with supplement use, with whole year daily users of cod liver oil experiencing a 44 percent lower risk, occasional users of other dietary supplements experiencing a 45 percent lower risk, and daily users of other supplements experiencing a 30 percent lower risk.

The authors note that their study is not the first to observe increase survival in lung cancer patients taking dietary supplements. “More research is needed to understand the interplay between nutrients whether in food or supplements, and cancer survival,” they conclude.

—D Dye

June 26, 2009

Soy intake associated with greater lung protection

In an article published online on June 26, 2009 in the journal Respiratory Research, scientists from Australia and Japan report that increased intake of soy foods is associated with improved lung function and a reduction in the risk of developing chronic obstructive pulmonary disease (COPD) in older men and women. The disease, which occurs mainly in smokers, is characterized by coughing, increased sputum production and shortness of breath, and is a leading cause of death and illness worldwide.

Dr Fumi Hirayama and Professor Andy Lee of Curtin University of Technology, Australia compared 278 Japanese men and women between the ages of 50 and 75 years with COPD to 340 individuals without the disease. Questionnaires were administered to obtain demographic and dietary information, including type and frequency of soy food consumption 5 years prior to the interview.

Patients without COPD were found to have a greater intake of fruit, vegetables, chicken and fish than those with the disease. Soy consumption was significantly higher in the control group compared to COPD patients, with those whose soy intake was among the top one-fourth of participants having a 61 percent lower risk of COPD than those whose intake was among the lowest fourth. A similar reduction in COPD risk was associated with tofu and soybean sprouts. Additionally, such symptoms as cough and breathlessness were associated with eating less soy than the amount consumed by those who did not have the symptoms.

"Soy consumption was found to be positively correlated with lung function and inversely associated with the risk of COPD,” Dr. Hirayama stated. “It has been suggested that flavonoids from soy foods act as an anti-inflammatory agent in the lung, and can protect against tobacco carcinogens for smokers. However, further research is needed to understand the underlying biological mechanism".

—D Dye

June 24, 2009

Specific Mediterranean foods associated with longer life

An article published online on June 23, 2009 in the British Medical Journal revealed that key components of the Mediterranean diet appear to be responsible for its association with longer life. The diet, which is traditionally consumed in countries surrounding the Mediterranean Sea, is characterized by frequent intake of vegetables, legumes, fruits and nuts, cereals, fish and seafood, and monounsaturated fats such as olive oil; low consumption of saturated fat, meat and dairy products, and moderate alcohol intake.

Professor Dimitrios Trichopoulos at the Harvard School of Public Health and his colleagues at the University of Athens reviewed data from 23,349 Greek participants in the European Prospective Investigation into Cancer and Nutrition, which is investigating the role of diet, lifestyle and other factors in the development of cancer and other diseases. Questionnaires completed upon enrollment were scored on a scale of 0 to 9 for adherence to Mediterranean dietary components. Participants were followed for an average of 8.5 years, during which any deaths were documented.

Over the follow up period, 423 deaths occurred among the 10,655 men and women whose Mediterranean diet scores were 5 or greater and 652 occurred among the 12,694 with scores of 4 or less. The researchers determined that moderate alcohol intake (which was mainly in the form of wine), lower intake of meat, and high consumption of vegetables, fruit and nuts, legumes and olive oil were linked with longer life span, while fish and seafood, cereals and dairy products appeared inconsequential.

The study is the first to investigate the impact of individual components of the Mediterranean diet on longevity. The authors reiterate the speculation of other researchers that oleic acid found in olive oil, the resveratrol and piceid in wine, and other antioxidants in olives and plant foods could be responsible for the diet’s protective benefits.

—D Dye

June 23, 2009

Canadian cardiovascular deaths down 30 percent in a decade

In just ten years, hospital admissions and deaths from cardiovascular disease dropped by 30 percent among Canadians, according to researchers at the Institute for Clinical Evaluative Sciences in Toronto. The study is the first of its kind in Canada.

The Canadian Cardiovascular Outcomes Research Team reported their analysis in the June 23, 2009 issue of the Canadian Medical Association Journal. The team utilized information obtained from Statistic Canada’s Canadian Mortality Database combined with admission data from the Canadian Institute for Health Information’s Hospital Morbidity Database for 1994 to 2004 to determine hospital admissions and rates of death for heart attack, heart failure and stroke per 100,000 individuals aged 20 and older.

They found that deaths from cardiovascular disease declined from 360.6 per 100,000 in 1994 to 252.5 per 100,000 in 2004: a 30 percent reduction. The rate of heart attack declined by 38.1 percent, and heart failure and stroke declined by 23.5 percent and 28.2 percent, with improvements in most age groups. While hospital admissions for heart attack decreased by 9.2 percent, the reduction in heart attack in-hospital fatalities was 33.1 percent.

For the first time, more women than men were found to have died from cardiovascular disease, although women were likelier than men to be admitted to the hospital for heart attack, heart failure and stroke at a later age.

The reduction in cardiovascular deaths could reflect a decline in smoking and greater use of statin drugs. In an accompanying commentary, Simon Capewell, DSc, and Martin O'Flaherty, MD of the University of Liverpool in England note that “Over 80% of premature cardiovascular disease is avoidable. Medications to reduce lipids and blood pressure will help. But the promotion of population-wide control of tobacco, cessation of smoking, a healthier diet and increased physical activity is crucial.”

—D Dye

June 19, 2009

More positive evidence for lutein and zeaxanthin in macular degeneration

In their presentation in Belfast, Ireland on June 19, 2009, Professor Usha Chakravarthy of Queen’s University Centre of Vision and Vascular Science and Dr Stephen Beatty of the Waterford Institute of Technology reported that a supplement containing high amounts of the carotenoids lutein and zeaxanthin in addition to the antioxidant nutrients zinc and vitamins C and E, helped preserve macular pigments in patients with age related macular degeneration (AMD), retarding the progression of early to late stage disease. Macular degeneration is the leading cause of vision loss among older individuals residing in western nations.

Professor Chakravarthy and colleagues administered the nutritional supplement or a placebo to 433 participants with early macular degeneration enrolled in centers in Belfast and Waterford, Ireland. The subjects, whose average age was 77 upon enrollment, were followed from October, 2004 to March, 2008.

While participants who received the placebo experienced a steady decline in protective macular pigments, these pigments were preserved in those who received lutein and zeaxanthin. "Late AMD causes severe sight loss and has a huge economic impact both in terms of the effects of sight loss itself and in terms of the expensive treatments that are needed to deal with the condition,” Dr Chakravarthy stated. "Up to 500 people a year in Northern Ireland will lose sight in one or both eyes as a result of late AMD . . . Prevention of progression to late AMD can result in a reduced financial and societal burden."

"These findings are important because this is the first randomized controlled clinical trial to document a beneficial effect through improved function and maintained macular pigments,” he noted. “Further research is needed to confirm these findings."

In the April, 2009 issue of the Journal of Clinical Endocrinology and Metabolism, researchers from Albert Einstein College of Medicine in New York report the discovery of a significant correlation between exceptional longevity and elevated levels of thyroid stimulating hormone (TSH, which increases production of hormones by the thyroid gland). According to the authors of the study, “subclinical hypothyroidism is diagnosed when serum TSH concentration is above the upper reference limit and free T4 remains within the reference range.” Hypothyroidism has been associated with extreme longevity in some animals as well as in some human studies, however, it is unknown whether it contributes to healthy aging.

The current study analyzed serum TSH and free T4 (thyroid hormone) levels in 232 Ashkenazi Jews with a median age of 97, 188 Ashkenazi Jews whose median age was 72, and 605 subjects aged 60 to 79 without thyroid disease who had participated in the National Health and Nutrition Examination Survey (NHANES) 1998-2002. Thyroid stimulating hormone was significantly higher in the older Ashkenazi Jews compared with both control groups, although T4 levels were similar in both Ashkenazi groups.

“Serum TSH concentrations and distribution gradually increase with age, suggesting either a decline in thyroid function or a reset in the TSH set point, which may occur with aging,” the authors write. “Although it remains unclear from numerous clinical studies whether altered negative-feedback between free T4 and TSH or subtle hypothyroidism raises the risk of adverse health outcomes, this, a priori, does not seem likely for individuals who have achieved exceptional longevity.”

They add that until the issue is settled, it may not be prudent for elderly patients who exhibit minimally increased TSH to be routinely treated with the thyroid hormone levothyroxine.

—D Dye

June 15, 2009

Red yeast rice reduces cholesterol without statin side effect

In an article published in the June 16 issue of the Annals of Internal Medicine, researchers at the University of Pennsylvania School of Medicine report that red yeast rice lowers low density lipoprotein (LDL) cholesterol but does not cause the muscle pain (myalgias) associated with statins, the number one drug treatment for high LDL.

David J. Becker and colleagues randomized 62 patients with elevated LDL and statin intolerance to receive 3 capsules containing 600 milligrams red yeast rice or a placebo twice daily for 24 weeks. Participants were additionally provided with weekly educational meetings over a 12 week period on the subjects of cardiovascular disease, nutrition, exercise and relaxation techniques. Total, HDL and LDL cholesterol and other blood values were measured at the beginning of the study, at 12 weeks, and at the study’s conclusion.

By 12 weeks, LDL cholesterol had decreased by 43 milligrams per deciliter (mg/dL) in the group that received red rice yeast and by 11 mg/dL in the placebo group. At the end of the 24 week treatment period, LDL cholesterol was 35 mg/dL lower than values measured at the beginning of the study in the red yeast rice group, and 15 mg/dL lower in the placebo group. Total cholesterol was also lower at both time points for those that received red yeast rice.

“To our knowledge, ours is the first randomized, double-blinded, placebo-controlled trial to evaluate red yeast rice in patients with a history of SAM [statin-associated myalgias],” the authors announce. “Red yeast rice significantly decreased LDL and total cholesterol levels compared with placebo and did not increase the incidence of myalgias over a 24-week period. The regimen of red yeast rice and therapeutic lifestyle change may offer a lipid lowering option for patients with a history of intolerance to statin therapy.”

In the June, 2009 issue of Cancer Epidemiology, Biomarkers & Prevention, researchers from Harvard Medical School and other centers report that men and women who consume greater amounts of fruit, vegetables and the carotenoids they contain have a lower risk of renal (kidney cell) cancer compared with those who consume lower amounts.

The current analysis pooled data from 13 prospective studies that included a total of 244,483 men and 530,469 women. Participants were followed for up to 7 to 20 years, during which 1,478 cases of renal cell cancer were identified. When those whose intake of fruit and vegetables was at least 600 grams per day were compared with those whose intake was less than 200 grams, their risk of renal cell cancer was 32 percent lower. There was a 21 percent lower risk for those who consumed at least 400 grams fruit compared with those whose intake was less than 100 grams, and for vegetables, the risk was 28 percent lower. Root vegetables and broccoli were specifically associated with lower risk.

Analysis of carotenoid intake revealed that subjects whose intake of alpha-carotene was among the top one-fifth of participants had a 13 percent lower risk of renal cell cancer compared with those in the lowest fifth. Similar risk reductions were observed for beta-carotene, beta-cryptoxanthin, and lutein and zeaxanthin.

The authors remark that the ability of carotenoids to inhibit oxidative damage to DNA, mutagenesis, tumor growth and malignant transformation, as well as their enhancement of cell to cell communication could be responsible for the protective association suggested by their analysis. “Our results provide evidence that the intakes of fruit and vegetables are associated with a reduction in renal cell cancer risk. Multiple bioactive compounds, including carotenoids, may contribute to this inverse association,” they conclude.

—D Dye

June 10, 2009

Prenatal vitamins improve birth weight

The results of a meta-analysis published online on June 9, 2009 in the Canadian Medical Association Journal revealed that supplementing pregnant women with multinutrient formulas is associated with a reduced risk of giving birth to low birth weight babies compared with the risk experienced by women who did not receive the extra nutrients. Low birth weight is significantly associated with increased infant mortality.

For their review, Prakesh S. Shah, MD and Arne Ohlsson, MD of the University of Toronto identified 13 trials that compared the effects of a micronutrient supplement with a placebo, or with iron and folic acid, which are currently recommended for pregnant women by the World Health Organization. The majority of the studies were conducted in developing countries in which nutritional deficiencies are common. Micronutrient supplements evaluated in the trials included vitamins A, B1, B6, folic acid, zinc, iron, and/or copper.

The risk of delivering a low birth weight infant was found to be 19 percent lower among women who received micronutrients compared with those who received a placebo, and 17 percent lower than those who received only iron and folic acid. Preterm birth risk and the risk of delivering infants who were small for their gestational age were approximately the same among treatment and control groups.

"Low birth weight and related complications are considered the most common cause of global infant mortality under the age of 5 years," the authors write. "With the possibility of reducing low birth weight rates by 17%, micronutrients supplementation to pregnant women, we believe, offers the highest possible return for the investment."

Meta-analysis finds reduced antioxidant vitamins in asthma

The results of a meta-analysis published in the April, 2009 issue of the journal Thorax revealed a higher incidence of asthma in men and women with low dietary intake of vitamins A and C. The review also found increased asthma severity associated with reduced serum levels of vitamin C and E.

For their review, researchers from the Division of Epidemiology and Public Health at the University of Nottingham in England selected 40 studies that included information on asthma and/or wheeze status and antioxidant vitamins, including vitamin A, alpha-carotene, beta-carotene, vitamin C and vitamin E. The team found that subjects with a low intake of vitamin A had a significantly greater risk of asthma than those whose intake was higher. Additionally, those with severe asthma consumed less vitamin A than those with mild asthma. Severe asthma patients were found on average to have half the recommended daily intake of vitamin A.

When vitamin C was evaluated, low intake was associated with a 12 percent greater risk of asthma and a 10 percent greater risk of wheeze compared to the risk experienced by those who consumed more of the vitamin. Having low serum levels of vitamin C was also associated with increased asthma risk. Although vitamin E intake did not appear to be related to asthma status, it was found to be significantly lower among those with severe asthma compared to mild asthma.

The authors acknowledge the plausibility of the findings, given the known antioxidant and anti-inflammatory actions of the vitamins, although epidemiologic evidence such as that evaluated in the current review does not establish causation. Randomized clinical trials of vitamin supplementation in asthma patients are needed to explore the effect of these antioxidants on the disease.

In an article published in the June 5, 2009 issue of the Journal of Biological Chemistry, researchers from Wake Forest University revealed that altering fatty acid intake to mimic the diet of early humans reduces the expression in humans of a gene that promotes inflammation. Increased systemic inflammation is associated with allergic and inflammatory diseases such as asthma, allergies, diabetes, cardiovascular disease and arthritis.

The Western diet includes a greatly increased intake of pro-inflammatory omega-6 fatty acids found in meat and vegetable oils and reduced amounts of omega-3 fatty acids that occur in fish and flax oil as compared to the diets of our ancestors. Evidence suggests that humans originally consumed a diet that contained a 2 to 1 ratio of omega-6 to omega-3 fatty acids as opposed to the current ratio which is greater than 10 to 1. For their study, the researchers administered a controlled diet to 27 volunteers for one week, after which the participants were supplemented with fish and borage oil for 4 weeks to reduce the ratio of omega-6 to omega-3 fatty acids.

At the end of the treatment period, omega-3 fatty acid content had risen, while the ratio of omega-6 to omega-3 fatty acids declined. The ability of white blood cells known as neutrophils to produce the inflammation marker leukotriene B4 was lowered by 31 percent. Also significantly lowered were cytokines interleukin-1beta, interleukin-10, and interleukin-23, as well as the expression of PI3K which is involved with immune signaling.

“This report demonstrates, for the first time in humans, that the expression of an early step (PI3K) in signal transduction, as well as several important downstream effectors, are significantly reduced by altering ingestion of polyunsaturated fatty acids to shift circulating omega-6 to omega-3 ratios,” the authors announce. “These data provide evidence that large changes in gene expression are likely an important mechanism by which polyunsaturated fatty acids exert their potent effects in clinical conditions.”

—D Dye

June 03, 2009

Low antioxidant intake could play a role in male infertility

In an article published online this year in the journal Fertility and Sterility, Spanish researchers report that reduced intake of antioxidants is associated with low semen reproductive capacity. Increased intake of nutrients that have an antioxidant activity, such as vitamin C, help lower dam aging oxidative stress, which affects semen quality.

Jaime Mendiola of the University of Murcia in Espinardo, Spain and his associates compared the diets of 30 fertility clinic patients with reproductive problems due to poor quality semen to the diets of 31 control patients with normal semen. Men in the control group were found to have a significantly greater intake of fiber, carbohydrates, vitamin C, folate, and lycopene and a lower intake of protein and fat than the men with reproductive difficulties.

"Our previous research study, published in March, showed that men who eat large amounts of meat and full fat dairy products have lower seminal quality than those who eat more fruit, vegetables and reduced fat dairy products,” Dr Mendiola stated. “In this study, we have found that people who consume more fruits and vegetables are ingesting more antioxidants, and this is the important point."

"We saw that, among the couples with fertility problems coming to the clinic, the men with good semen quality ate more vegetables and fruit than those men with low seminal quality," he noted. "A healthy diet is not only a good way of avoiding illness, but could also have an impact on improving seminal quality. What we still do not understand is the difference between taking these vitamins naturally and in the form of supplements. In the studies we are going to carry out in the United States (where the consumption of vitamins in tablet form is very common) we will be looking at the role of supplements."

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